A Day in the Life: Family Medicine Physician Assistant

Emily Knochel

Family Medicine PA

Midwestern University, Glendale, AZ 2008

1. What is your specialty? Where do your work?

I work in family practice in Phoenix Arizona.  I have also worked in pulmonology and critical care before coming to family practice.

2. What is a typical day like?

My clinic days are Tuesday, Wednesday, Thursday, and Friday from 8-4:15 with a 2 hour lunch break for admin/phone/lunch. I see about 16-18 patients on average per day; usual visits are about 15 minutes.  I spend a few minutes in the mornings and at lunchtime and after clinic reviewing labs, answering telephone messages, reviewing medical records, calling patients, and charting.  Mondays are my administrative days and I am able to work from home. I will usually put in 1-5 hours on my admin days, depending on how busy I am or if I’m catching up on charts. Ultimately, I work in about 42-44 hours total a week.

3. What attracted you to your particular specialty originally?

The long-term relationship with patients and their family members, as well as utilizing ALL the stuff I learned in school.  Practicing general medicine forces me to stay current on all areas of medicine and constantly presents me with challenges, even after practicing this specialty for 5 years.

4. What do you find most interesting about your current specialty?

Personally, I enjoy diagnosing and treating gastrointestinal and cardiac disorders.

5. What special skills are required? Skills you learn once you were hired?

I would say the most important skill to have in family practice is listening to the patient.  Medical histories are important when you are seeing the patient for the first time for a particular problem.  As far as skills I learned since being hired, I have learned several in-office procedures, such as skin lesion biopsy/removal, joint injections/aspirations, nail removal, trigger point injections, hemorrhoid removal, I&D of abscesses.  There are also a variety of physical exam skills I’ve learned or improved since starting family practice.

6. What do you like most about being a PA?

Having a skill set and knowledge base that is constantly growing.  Practicing medicine means lifelong learning!

7. What are the challenges of your particular specialty?

Administrative demands are higher in FP than in most specialties (more time is required to answer telephone calls, request authorization for medications and tests from insurance companies, reviewing labs, medical records, etc).

8. Any other advice you’d like to share?

Prior to PA school, I would advise potential students to get as much hands-on experience with patients in as many different healthcare settings as possible.

A Day in the Life: Psychiatry Physician Assistant

Allyson Gelman, MPAS, PA-C

Psychiatry PA

Graduated from UTMB in 2014

1. What is your specialty? Where do you work?

I work in Outpatient Psychiatry at Holistic Psychiatry in Kingwood, TX

2. What is a typical day like?

I get to the clinic at 8am after my 40 minute commute from home and I immediately start seeing patients. Follow-ups are 15 minutes and new patients take 30-45 minutes. I typically see about 22-26 patients a day, mostly follow ups and about 2-5 new patients per day. Things are very hectic at our clinic with the amount of patients I am expected to see. My role is primarily medication management. I treat patients for depression, anxiety, bipolar, ADHD, PTSD, opioid addiction, schizophrenia, and OCD. I prescribe antidepressants, mood stabilizers, anxiolytics, sedative hypnotics, and stimulants. Another thing I prescribe is buprenorphine which is an opioid replacement medication to help patients who are addicted to opioids get sober and then maintain their sobriety. Our clinic offers ADHD testing in the office called the TOVA test and we also do TMS (Transcranial Magnetic Stimulation) for treatment-resistant depression. I share a wall with the room where they do those two things so I hear it going on throughout the day in the background. I typically get out on time right around 5pm. I return messages throughout the day between patients. My staff does all the paperwork and prior authorizations for me so I just have to see patients and chart mostly.

I work Monday – Friday 8-5 with lunch from 12-1, 40 hours a week.

3. What attracted you to your particular specialty originally?

I have always had an interest in psychology since I come from a long line of people who suffer from mental illness. Initially I wanted to be a primary care provider but it never really worked out and I just sort of fell into psychiatry because there was a job opening so I took it. So far it is the best specialty I have worked in. I just see patients, talk to them about their problems, and prescribe medications. I don’t have to do any procedures which is something I never enjoyed anyways.

4. What do you find most interesting about your current specialty?

There is never a dull moment. My patients tell me some very interesting stories about their lives. They feel comfortable opening up to me about their love lives, their children, traumas they have experienced, anything you can think of, which I absolutely love. I always wanted to develop long term relationships with my patients instead of being in a setting where I would treat them once and never see them again like in the ER or urgent care.

5. What special skills are required? Skills you learn once you were hired?

There were no special skills required for this job. My knowledge of psychiatric drugs was pretty good before but expanded rapidly as I learned on the job. I also learned about time management and how to make the visits with patients shorter and keep the flow going which was something I really struggled with in my first few years of being a PA.

6. What do you like most about being a PA?

The flexibility to be able to work in different specialties. After PA school I worked in allergy/asthma, then family medicine, and now psychiatry. I like that my job has primarily always been just seeing patients and charting. Working in private practice, it’s usually the doctor who has to do more of the business/administrative tasks to keep the clinic running. I am happy with my supervising physician being the person who owns the clinic and takes care of business decisions.

7. What are the challenges of your particular specialty?

Patients put too much faith in the medications that I prescribe them to fix all their problems. It’s draining when they come back for a follow-up and they are still depressed despite me trying so many different things. I try to explain to them that they need to give the medication time to work and also to do therapy and get out of their house once in awhile. They complain to me for a long time about all the things going wrong in their lives and I have to constantly redirect them to stay on track and discuss the medications in the limited amount of time we have. There are some days it’s hard for me not to want to cry hearing about their problems all day long, but the longer I do this the easier it gets.

8. Any other advice you’d like to share?

There is never going to be a perfect job out there.  You have to decide what you are willing to tolerate and compromise about some aspect whether it’s the amount of paperwork, the amount of patients you are expected to see, the coworkers, the types of patients, or call schedule. No matter what it is going to be challenging, but hopefully it will be rewarding too.

5 Tips for Landing a PA Shadowing Experience

Having PA shadowing experiences is a critical part of any PA school application. Once you land a PA school interview (fingers crossed), every interviewer will ask you about your shadowing experience or lack there of. To give yourself the best chance of acing these questions and bolstering your application overall, the importance of securing a shadowing experience cannot be over emphasized.

But how does one go about finding a PA to shadow? This is one of the most common questions that I address with pre-PA students. With just a little creativity and tenacity, you can land the perfect PA shadow experience. But here are my top 5 tips to get you started:

1. Ask a PA at your personal Doctor’s office- simplest idea first! Most people either see a PA themselves or are patients at an office that employs PAs. If you are lucky enough to have a PA as a provider, ask them if you can shadow (ask for a very a limited commitment to start with). If they agree, this could lead to more hours or very likely open the door to other PAs that you can shadow. If you don’t know any PAs already, see if any work at any of the offices you are already a patient. If so, ask if you can get their email and then ask away! Talking to one PA, always leads to more PAs (yeah, we are tight like that!) so even if the one you ask says no, they almost certainly will try to help you find someone else you can shadow.
2. Call your local PA program- PA programs (and their websites) often have ideas and even specific contacts for shadowing opportunities. Even if your local PA program doesn’t end up having any specific suggestions, it’s always a great idea to call programs and introduce yourself to get on their radar. You’d be surprised that even a short phone call could stand out at an admissions committee meeting, over another applicant they have never heard from.
3. Check out http://pashadowonline.com/ – Finally someone answered our prayers and created a forum to match PAs willing to shadow with interested pre-PA students! Once you register, you can search by your city and even see the PA’s typical work schedule. PAs can be contacted directly through the site by e-mail.
4. Search the AAPA or state PA society directories- The AAPA lists members by state and practice specialty. This is a great resource but you have to be a member with a login to search this resource. It certainly looks good to programs to join the AAPA or state PA society as an applicant (and usually the cost is nominal) but it is certainly not a necessity. State PA societies often have links to regional or city PA groups. Some even mention PA shadowing programs specifically. State/Regional groups are great resources and a good place to start introducing yourself to other PAs in your area and start networking!
5. PA specialty groups- This is a great list if you already have identified a specialty you are interested in gaining experience in or even working in after PA school. From Neurology and Surgery to Dermatology, these groups often have directories of members, so you can search for a PA in your area. In addition, some have student resources that can apply to Pre-PA students.

Hopefully this list will give you a good starting point and in not too long, land you the perfect PA shadowing gig! Good luck!

-Deborah